Leg Swelling and Lymphoedema

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Leg Swelling and Lymphoedema

Postby patoco » Sat Jun 10, 2006 9:55 pm

Leg Swelling and Lymphoedema

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Lymphedema People

http://www.lymphedemapeople.com/

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Leg Swelling and Lymphoedema

Related Terms:

Oedema, Edema, Fluid Retention, Water Retention, Swollen Leg, Lymphoedema, Lymphedema

Leg Swelling

Leg swelling is not uncommon and has been experienced by many many people. Usually, this swelling is temporary and goes away after the underlying condition is healed.

Temporary Leg Swelling

This temporary leg swelling may be caused by an infection, burn or sunburn, insect bites, an injury to the leg such as a sprain, surgery, or even medications such a hormone drugs, steroids, blood pressure drugs. This may also be an part of the inflammatory response your body goes through it trying to protect and heal the leg from the cause of the trauma.

Long Term Leg Swelling.

Long term leg swelling is referred to as edema. This is usually related to specific medical conditions. These conditions may include diabetes, congestive heart failure, blood clot, varicose veins, kidney failure, liver failure or a number of cardio-vascular problems.

Treatment for this long term swelling is in conjunction with the treatment for the condition that caused it. Usually diuretics are also used to relieve the swelling or water-retention.

Permanent Leg Swelling

****In the situation of any permanent leg swelling whether the cause is known or unknown, the diagnoses of lymphedema must be considered****

There are several groups of people who experience leg swelling from known causes, but it doesn't go away or unknown causes where the swelling can actually get worse as time goes by.

Group One

This group includes those who have had the injuries, infections, insect bites, trauma to the leg, surgeries or reaction to a medication. When this swelling does not go away, and becomes permanent it is called secondary lymphoedema.

Group Two

Another extremely large group that experiences permanent leg swelling are cancer patients, people who are morbidly obese, or those with the condition called lipoedema. What causes the swelling to remain permanent is that the lymph system has been so damaged that it can no longer operate normally in removing the body's waste fluid.

In cancer patients this is the result of either removal of the lymph nodes for cancer biopsy, radiation damage to the lymph system, or damage from tumor/cancer surgeries.

This is also referred to as secondary lymphoedema.

Group Three

Group three consists of people who have leg swelling from seemingly unknown reasons. There may be no injury, no cancer, no trauma, but for some reason the leg simply is swollen all the time.

The swelling may start at birth, it may begin at puberty, or may begin in the 3rd, 4th or even 5th decade of life or sometimes later.

This type of leg swelling is called primary lymphoedema. It can be caused by a genetic defect, malformation or damage to the lymph system while in the womb or at birth or be part of another birth condition that also effects the lymph system.

This is an extremely serious medical condition that must be diagnosed early, and treated quickly so as to avoid painful, debilitating and even life threatening complications. Treatment should NOT include the use of diuretics.

What is Lymphoedema?

Lymphoedema is defined simply as an accumulation of excessive protein rich fluid in the tissues of the leg. The accumulation of fluid causes the permanent swelling caused by a defective lymph system.

A conservative estimate is that there may be 1-2 million people in the United States with some form of primary lymphoedema and two to three million with secondary lymphoedema.

How is Lymphoedema Treated?

The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual decongestive therapy (MDT), there are variances, but most involve these two type of treatment.

It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally.

With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size.

What are the symptoms of Lymphoedema?

If you are an at risk person for leg lymphoedema there are early warning signs you should be aware of. If you experience any or several of these symptoms, you should immediately make your physician aware of them.

1.) Unexplained aching, hurting or pain in the leg.

2.) Experiencing "fleeting lymphoedema." This is where the limb may swell, even slightly, then return to normal. This may be a precursor to full blown leg lymphedema.

3.) Localized swelling of any area. Sometimes lymphoedema may start as swelling in one area, for example the foot, or between the ankle and knee. This is an indication of early lymphatic malfunction.

4.) Any arm inflammation, redness or infection.

5.) You may experience a feeling of tightness, heaviness or weakness of the leg.

What are some of the complications of lymphoedema?

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphoedemous limbs are localized immuno-deficient.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphoedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

Can lymphoedema be cured?

No, at the present time there is no cure for lymphedema. But it can be treated and managed and most of the complications can be avoided. Life with lymphedema can still be active and full, with proper treatment, patient education, and patient life style adaptation.

For extensive information on lymphoedema, please visit our home page:

Lymphedema People

http://www.lymphedemapeople.com

(c) Copyright 2005 by Pat O'Connor and Lymphedema People. Use of this information for educational purpose is encouraged and permitted. It must be available free and without charge and not used for financial renumeration or gain. Please include an acknowledgement to the author and a link to Lymphedema People.

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Foot, leg, and ankle swelling

Alternative names

Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral, Peripheral edema

Definition

Abnormal buildup of fluid in the ankles, feet, and legs is called peripheral edema.

Considerations

Painless swelling of the feet and ankles is a common problem, particularly in older people. It may affect both legs and may include the calves or even the thighs. Because of the effect of gravity, swelling is particularly noticeable in these locations.

Common Causes

Foot, leg, and ankle swelling is common with the following situations:

Prolonged standing

Long airplane flights or automobile rides

Menstrual periods (for some women)

Pregnancy -- excessive swelling may be a sign of pre-eclampsia (a serious condition that includes high blood pressure and swelling; sometimes called toxemia)

Being overweight

Increased age

Injury or trauma to your ankle or foot

Swollen legs may be a sign of heart failure, kidney failure, or liver failure. In these conditions, there is too much fluid in your body.

Other conditions that can cause swelling to one or both legs include:

Blood clot

Leg infection

Venous insufficiency (when the veins in your legs are unable to adequately pump blood back to the heart)

Varicose veins

Burns including sunburn

Insect bite or sting

Starvation or malnutrition

Surgery to your leg or foot

Certain medications may also cause your legs to swell:

Hormones like estrogen (in birth control pills or hormone replacement therapy) and testosterone

A group of blood pressure lowering drugs called calcium channel blockers (such as nifedipine, amlodipine, diltiazem, felodipine, and verapamil)

Steroids

Antidepressants, including MAO inhibitors (such as phenelzine and tranylcypromine) and tricyclics (such as nortriptyline, desipramine, and amitriptyline)

Home Care

Elevate your legs above your heart while lying down.

Exercise your legs. This helps pump fluid from your legs back to your heart.

Wear support stockings (sold at most drug and medical supply stores).

Try to follow a low-salt diet, which may reduce fluid retention and swelling.

Call 911 if:

You feel short of breath.

You have chest pain, especially if it feels like pressure or tightness.

Call your doctor right away if:

You have decreased urine output.

You have a history of liver disease and now have swelling in your legs or abdomen.

Your swollen foot or leg is red or warm to the touch.
You have a fever.

You are pregnant and have more than just mild swelling or have a sudden increase in swelling.

Also call your doctor if self care measures do not help or swelling worsens.

What to expect at your health care provider's office

Your doctor will take a medical history and conduct a thorough physical examination, with special attention to your heart, lungs, abdomen, legs, and feet.

Your doctor will ask questions like the following:

What specific body parts swell? Your ankles, feet, legs? Above the knee or below?
Do you have swelling at all times or is it worse in the morning or the evening?
What makes your swelling better?
What makes your swelling worse?
Does the swelling get better when you elevate your legs?
What other symptoms do you have?
Diagnostic tests that may be performed include the following:

Blood tests such as a CBC or blood chemistry
ECG
Chest x-ray or extremity x-ray
Urinalysis

The specific treatment will be directed at whatever underlying cause is found. Diuretics may be prescribed. These are effective in reducing the swelling but have some side effects. Home treatment for benign causes of leg swelling should be tried before drug therapy under medical supervision.

Prevention

Avoid sitting or standing without moving for prolonged periods of time. When flying, stretch your legs often and get up to walk when possible. When driving, stop to stretch and walk every hour or so. Avoid wearing restrictive clothing or garters around your thighs. Exercise regularly. Lose weight if you need to.
Update Date: 9/21/2003

http://www.nlm.nih.gov/medlineplus/ency ... 003104.htm

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Swelling

Alternative names:

pitting edema; dependent edema; generalized swelling; edema; anasarca

Definition:

Excessive build-up of fluid in the tissues, or an increase in tissue mass. Swelling can occur throughout the body (generalized swelling) or swelling can be limited to a specific part of the body.

See also:

ankle, feet, and leg swelling
angioedema
swollen gums
swollen glands
facial swelling
swelling in the abdomen
breast enlargement
scrotal swelling
joint swelling

Considerations:

This document primarily discusses overall swelling. See the specific documents listed in the definition for information that is specific to swelling in a specific location.

Slight edema of the legs commonly occurs in warm summer months.

Generalized swelling or massive edema (also called anasarca) is a common sign in severely ill people. While slight edema may be difficult to detect, especially in an overweight person, massive edema is very obvious.

Very often, widespread edema is both long-term and progressive and the causes vary significantly.

Edema may be pitting (when pressing a finger against a swollen area for 10 seconds and then quickly removing it, an indentation is left that fills slowly) or nonpitting (when pressing a finger against a swollen area for 10 seconds and then quickly removing it, no indentation is left in the skin).

Common causes:

lymphoedema
burns
sunburn
too little albumin in the blood (hypoalbuminemia)
malnutrition
pregnancy
drugs
androgenic and anabolic steroids
antihypertensives
corticosteroids such as prednisone (causes sodium retention)
estrogens
anti-inflammatory drugs (see NSAIDs)
intravenous saline administration or tube feedings
nephrotic syndrome
acute glomerulonephritis

Note: There may be other causes of swelling. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as location, quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for swelling, occurring alone or in combination with other problems.

Home care:

Follow prescribed therapy to treat the underlying cause of the edema. Discuss with your health care provider the options to prevent skin breakdown (for chronic edema) such as a pressure mattress, lamb's wool pad, or flotation ring.

Maintain everyday activities. Walk rather than stand. Stand or lie rather than sit. When lying down, keep limbs above the heart level, if possible, to facilitate drainage. Do not do this if shortness of breath results.

Massage swollen areas regularly, particularly if edema has formed around the hip, buttocks, or back.

Reduced sodium (salt) in the diet may be recommended.

Call your health care provider if:

there is any unexplained swelling.
What to expect at your health care provider's office:
Except in emergency situations (such as cardiac failure or pulmonary congestion), the medical history will be obtained and a physical examination performed.

Medical history questions documenting swelling in detail may include:

time pattern
When did you first notice this?
Is it present all the time?
Does it come and go?
quality
How much swelling is there?
When you poke the area with a finger, does the dent remain?

location

Is it overall or in a specific area (localized)?
If swelling is in a specific area, what is that area?

other

What seems to make the swelling better?
What seems to make the swelling worse?
What other symptoms are also present?

Diagnostic tests that may be performed include:

albumin levels measured
ECG
echocardiography
serum electrolyte tests
urinalysis
X-rays

Intervention:

Treatment may include fluid and sodium restriction, diuretics, digoxin, and (rarely) intravenous albumin administration. In some cases corticosteroids such as prednisone or immunosuppressive medications may be given. Fluid intake and output should be monitored and the patient should be weighed daily.

Avoid alcohol if liver disease (such as cirrhosis and hepatitis) is the problem. Vascular support hose (TED hose) may be advised.

After seeing your health care provider:

You may want to add a diagnosis related to swelling to your personal medical record.

http://www.healthcentral.com/mhc/top/003103.cfm

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Pub Med - Links to Articles on Leg Swelling

http://www.ncbi.nlm.nih.gov/entrez/quer ... &DB=PubMed

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Cause of leg swelling

http://www.eurorad.org/case.cfm?uid=2871

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Leg Pain and Swelling

http://www.embbs.com/aem/leg.html

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patoco
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